We propose the establishment of the HARLEM HOSPITAL CENTER URBAN HEALTH INSTITUTE. The goal of the Institute will be to help optimize the utilization of medical resources and services in urban African-American populations. This goal will be approached by examining the variability that exists in current medical practice and services provision and by investigating how clinical outcomes may be related to practice variation. The findings of these studies will be communicated to health care providers so that the most successful and effective clinical and organizational strategies may more rapidly replace inferior ones. The Theme of the Center is "Health Through the Ages: Effective and Appropriate Health Care for Harlem" and stresses health problems whose incidence is disproportionately high in Harlem (such as hypertension and heart disease, tuberculosis, AIDS, violence and injury to children and adolescents, and teenage pregnancy). The Institute will: (1) Assemble a cadre of researchers and develop an integrated group of resource teams and facilities to develop, conduct and disseminate outcomes research, assist and train others in the conduct of outcomes research and disseminate recommendations and findings evolving out of these activities. (2) Conduct research on the effectiveness of medical care and the variations in medical practices, including prevention, diagnosis, treatment and management in four sub-areas of clinical emphasis. (3) Provide technical assistance in the major areas of outcomes research, analysis of variations in medical practice and their association with patient outcomes, literature review and synthesis (including meta-analysis), management and analysis of large and small data bases, survey research, health economics, decision analysis, epidemiology and biostatistics. (4) Develop curricula and establish training programs for college students, medical students and masters and doctoral candidates, residents and fellows, nurses and other health providers, practicing physicians, researchers, lay and professional organizations and public and private health agencies in interested in conducting outcomes research. (5) Establish linkages with local, regional and national data bases for the conduct of integrated and collaborative outcomes research which will provide data specific to the health of urban African-Americans. (6) Develop cooperative relationships with clinical centers which serve large numbers of urban African-Americans in several cites for the conduct of studies comparing practice patterns and clinical outcomes. (7) Develop cooperative arrangements with professional organizations composed of practicing physicians which would allow assessment of practice variations and clinical outcomes in urban African- American and other American populations. (8) Develop and evaluate strategies for the dissemination of research findings and practice recommendations to providers, patients and the public which are ethnically and culturally appropriate. (9) Serve as a resource to others for information, technical assistance, training and dissemination strategies in medical effectiveness research. (10) Facilitate continued development of outcomes researchers.